Does the Insurance Industry intend to destroy Chiropractic by driving DCs out of practice by nonsensical lawsuits?

[caption id="attachment_18" align="alignright" width="300" caption="Modesto DC suing for $5 million"][/caption]Friday, Oct. 02, 2009

Modesto chiropractor suing for $5M

Claim names SJ County, insurer, two DA workers

By Merrill Balassone
mbalassone@modbee.com Buzz up!

A Modesto chiropractor once charged with defrauding insurers and workers compensation out of millions of dollars wants to clear his name.

Wilmer Origel, who endured 18 days in jail, raids on his offices and suspension of his chiropractic license, filed a multi-million dollar lawsuit in federal court last week against those who unsuccessfully prosecuted him.

A San Joaquin County jury voted 10-2 in favor of acquitting Origel on charges of overbilling insurance companies in excess of $1 million, performing controversial adjustments on anesthetized patients and money laundering. Prosecutors decided not to retry Origel in November.

At 49, Origel said he's starting life over.

"I won my freedom, but they still won," he said. "I lost everything."

Origel is suing San Joaquin County, two employees of the district attorney's office and Travelers Property and Casualty Company of America, an insurance company Origel's lawyer said pulled the strings in the criminal probe.

Origel is seeking $5 million plus punitive damages.

The defendants in the case did not return calls or declined to comment on the lawsuit's specifics.

Among the case's controversial aspects is that Origel and other chiropractors performed and charged insurers for a procedure called manipulation under anesthesia.

It requires an anesthesiologist to provide pain medication before a chiropractor works on muscles or adjusts joints or the spinal column. Patients typically have such serious injuries that back or neck surgery are treatment options.

During the 2½ month trial, prosecutors alleged the procedure was illegal.

But some insurers, including the worker compensation program, cover MUAs, and the California Chiropractic Association recognizes MUAs as an alternative to more risky surgical procedures.

Origel's attorney, Rob Waters, said Traveler's Insurance pushed Origel's case forward to intimidate chiropractors from performing the expensive procedures. Prosecutors said they cost $35,000 to $40,000.

Waters said the insurance company won in one sense: Origel, who has practiced since 1989, suffered "professional death," at their hands.

"Just because an insurance company does not want to pay for a procedure does not make that procedure unnecessary or illegal," Waters said.

Origel was at the helm of Med-1 Medical Centers, a chiropractic office that also employed medical doctors. The six locations, including those in Modesto, Turlock and Ceres, are closed.

"They basically shut us down," Origel said. "They destroyed us. And I think that was their intent from the very beginning."

Origel said he filed the civil rights lawsuit in part to send a message.

"Out of 36 charges, they couldn't even get a misdemeanor," Origel said. "They didn't have a single shred of evidence. I need to strike back so they think twice before they attack an innocent person."

Bee staff writer Merrill Balassone can be reached at mbalassone@modbee.com or 578-2337.

For information on ways to effectively address the issue of healthcare fraud & abuse, a multi-billion dollar menace, contact us today for a free consultation.

Turning up the HEAT on healthcare fraud & abuse!

The US Justice Department created the Health Care Fraud Prevention and Enforcement Action Team, or “HEAT,” program to put a dent in the fraud perpetrated against Medicare and Medicaid. For details on HEAT, click here

The problem with the HEAT program is that it is limited to four states and ignores the vast majority of the country.

The Justice Department claims, rather naively that:

"Most health care providers are doing the right thing and providing care with integrity. But sadly, due to the illegal actions of a small but active group of heath care fraud perpetrators, billions of dollars are stolen from taxpayers each year. Medicare fraud schemes have grown bolder and more elaborate, resulting in billions of dollars in false billings and fraud schemes which are robbing Medicare and Medicaid blind and leaving our most vulnerable citizens at
risk. Medicare fraud affects every American. Not only is waste, fraud and abuse taking critical resources out of our health care system, it contributes to the rising cost of health care for all Americans and harms the short-term and long-term solvency of these essential programs.

"Eliminating fraud will cut costs for families, businesses and the federal budget and increase the quality of services for those who need care. The U.S. Department of Health and Human Services (HHS) and U.S. Department of Justice (DOJ) are working together to help eliminate fraud and investigate fraudulent Medicare and Medicaid operators who are cheating the system. Attorney General
Eric Holder and HHS Secretary Kathleen Sebelius are taking the fight against Medicare and Medicaid fraud to a new level. They have committed senior officials from HHS and DOJ to work together on the Health Care Fraud Prevention and Enforcement Action Team (HEAT)."

The HEAT Team will expand efforts to stop fraud and prevent it from happening in the first place. These efforts will include:

Stopping Those Who Perpetrate Fraud:

• Continuing to utilize Strike Force teams that fight fraud in Miami and Los Angeles;
• Creating Strike Force teams in Detroit and Houston; and
• Helping State Medicaid officials conduct provider audits and monitor activities to detect fraudulent activities.
• Using modern technology to complete in a matter of days analysis of electronic evidence that previously took months to analyze using traditional investigative tools.
• Background on the Health Care Fraud Prevention and Enforcement Action Team.
• Criminal Prosecution as a Deterrent to Health Care Fraud, Testimony of Lanny Breuer, Assistant Attorney General for the Criminal Division, before the Senate Judiciary

Committee's Subcommittee on Crime and Drugs, 5/20/2009.

According to the Justice Department, in criminal enforcement actions during 2008, Department prosecutors:

1. Opened 957 new criminal health care fraud investigations involving 1,641 defendants, and had 1,600 criminal health care fraud investigations involving 2,580 potential defendants pending at the end of the fiscal year; and

2. Filed criminal charges in 502 health care fraud cases involving charges against 797 defendants and obtained 588 convictions for the year. Each of these figures represents an “all time high” count of federal criminal cases, defendants, and convictions.

Another 773 criminal health care fraud cases involving 1,335 defendants were pending at the end of FY 2008. In 2008, the Government charged 37 defendants in 21 indictments involving more than $55 million in fraudulent Medicare claims .

Since its inception two years ago, the Strike Force, with a limited number of investigators and prosecutors, has:

• filed 108 cases charging 196 defendants who collectively billed the Medicare program more than half a billion dollars;
• taken 129 guilty pleas;
• handled 14 jury trials resulting in convictions of 18 defendants; and
• obtained 109 sentences of imprisonment, ranging from 30 years to 4 months of home confinement, with an average term of imprisonment of 48 months.

It seems strange to hear politicians claim that they will save $500 billion by reducing fraud and abuse when with a special task force in place the US filed only 108 cases charging 196 defendants in two years and took only 14 cases to trial regarding 18 defendants with minimal recoveries from the participants. To effectively limit health insurance fraud (both against government and private
insurance programs) that steal over $100 billion every year it will be necessary to do more than pilot projects that have only covered four cities in four years.

It is time to properly fund the enforcement divisions and get more serious verdicts like some of those reported in the “Good News” sections below.

For more information on this and related topics, click here.